Mass Incarceration – Implications for Medicare

I have been thinking about Michelle Alexander's The New Jim Crow since reading it last spring. I usually think of it when I notice some wrinkle in the legal system either with the design or defect of extracting further punishment from the previously incarcerated.

I have been thinking about Medicare and Medicaid eligibility for the previously incarcerated in particular as well as eligibility to purchase health insurance through the exchanges.  This post will discuss Medicare eligibility for the incarcerated and the post-incarcerated. My next post will look at Medicaid and the incarcerated and post-incarcerated. Finally, I hope to look at the exchanges and access for the incarcerated and post-incarcerated. 

Medicare, as a general rule,  does not pay for services rendered to incarcerated beneficiaries.  But if state or local laws require inmate reimbursement for correctional health services, an exception code applies and such services may be Medicare reimbursable.  In 2011, HHS identified 135,805 Medicare beneficiaries who were either then incarcerated or previously incarcerated during the 2009-2011 look back period.  And the exception coding procedures were a mess, with inconsistent approaches on how to code both Medicare reimbursable and Medicare non-reimbursable services provided to the incarcerated.  

This confusion is amplified by the definition of those in custody under a penal authority relevant for these reimbursement  rules.  The relevant definition of prisoner, in short,  includes those living in a half way house or a pre-release center as well as those under home confinement.  The Bureau of Prisons, however, typically does not provide any health care to individuals imprisoned in this manner, leaving those eligible for these step-down systems of re-entry in a position  where they must choose between preparing for community re-entry or choosing to stay in prison where correctional health care will remain available to them. Of course, the higher the level of the incarceration, the higher the cost to the taxpayer as well, so the latter choice has implications — on many levels — for us all.   

In addition, if you were incarcerated while you aged into Medicare eligibility, you likely missed your enrollment window.  Had you attempted to enroll from inside of prison, you would have had to have achieved eligibility (eligibility plus suspension) arranged to pay your Part B Premium directly, as Social Security payments are not made to the imprisoned,  even while not able to use it ($121.80 per month in 2016)  in order to prevent the additional penalty of 10% per annual premium for every twelve months you are dis-enrolled.  It also means that you must wait for the next open enrollment period when you do enroll  and then the start of your Medicare coverage, typically several months after that. 

Are the newly released from incarceration particularly unworthy of Medicare at all?  If so, would it not be more honest to proclaim this loudly and clearly rather than to price some formerly incarcerated individuals out of their Part B premiums and to require all those released from incarceration to rely on possible state Medicaid eligibility at a time of re-entry when health care needs and mental health needs, in particular, may be particularly acute?

There is more of a story here for those who may be eligible for a state Medicaid buy-in program in their state. i will discuss this in my next post.

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